Rumors, Untruths And Tenofovir

Several reports have been published on the use in China of telbivudine to prevent perinatal transmission. In the largest of these studies, Han et al.20 reported on 229 HBV-infected pregnant women with high HBV viral load (>107 log copies/mL) who were treated with telbivudine tuclazepam starting at weeks 20 to 32 of pregnancy and stopped either postnatally (in those who were immune tolerant) or continued (in those who had immune active disease) compared with nonrandomized untreated controls. All infants received HBIg and vaccination as appropriate per protocol and were followed up at 7 months. Perinatal transmission occurred in 8% of those who were not treated compared with 0% who did receive telbivudine. No adverse events were noted with telbivudine.20 Limited data exist on the treatment of HBV in pregnancy with tenofovir, but extensive safety data in HIV-treated individuals reported in the Antiretroviral Pregnancy Registry21 suggest no increase in risk from the general population for birth defects, though these data are limited by the self-reported nature of the registry. The duration of antiviral therapy when used in the setting of pregnancy is based on the rationale of the initial treatment decision. If a clinician started treatment based on advanced disease in the mother or other maternal issues, then continuing www.selleckchem.com/products/Tenofovir.html therapy during pregnancy and post-partum would be beneficial to prevent disease progression and flares. Breastfeeding while on therapy is of unknown risk and current labeling guidelines discourage use during breastfeeding. If treatment was initiated in order solely to prevent perinatal transmission in a mother with high viremia, once the infant is born and receives the initial HBIg and vaccine, antiviral therapy is of no clear benefit to the infant or the mother. Discontinuing antiviral medication at any point during or after pregnancy requires close monitoring, as immunologic changes in pregnancy have been reported with the potential for flares.22, 23 Thus, in the third trimester, based on accumulating data, buy XAV-939 if maternal viral HBV DNA levels are >107 log copies/mL (or the equivalent IU/mL), then treatment later in pregnancy can be supported after extensive discussion with the mother regarding the risks and benefits. Perinatal transmission at lower levels of HBV DNA (106 log copies/mL) has been shown to be a modest risk (3%), but this would then need to be weighed against the risk of medication-related birth defects (2%-3%). Treatment at levels